AFFORDABLE DENTAL OF ILLNOIS
Complete NPI Record 1154712784
Clinic/Center - Dental in Dupo, IL
Active since February 18, 2015
Complete NPI Dataset
This page contains the complete raw NPPES record for Affordable Dental Of Illnois (NPI 1154712784), a clinic/center organization in Dupo, IL. All 33 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
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Registry File Document Utilities
- NPI: 1154712784 Field 1/33
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 2 Field 2/33
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Employer Identification Number EIN: Not available Field 3/33
- The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
- Provider Organization Name Legal Business Name: EDP OF ILLINOIS P.C Field 4/33
- The name of the organization provider. If the provider is an organization, this is the legal business name.
- Provider Other Organization Name: AFFORDABLE DENTAL OF ILLNOIS Field 5/33
- Other name by which the organization provider is or has been known.
- Provider Other Organization Name Type Code: 3 Field 6/33
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 141 W JACKSON BLVD STE 210 Field 7/33
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: CHICAGO Field 8/33
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: IL Field 9/33
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 606043048 Field 10/33
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 11/33
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 3128001270 Field 12/33
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 195 S MAIN ST Field 13/33
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: DUPO Field 14/33
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: IL Field 15/33
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 622391347 Field 16/33
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 17/33
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 3128001270 Field 18/33
- The telephone number associated with the location address of the provider being identified.
- Authorized Official Last Name: GARIBAY Field 21/33
- The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
- Authorized Official First Name: MELISSA Field 22/33
- The first name of the authorized official.
- Authorized Official Title or Position: CREDENTIALING MANAGER Field 23/33
- The title or position of the authorized official.
- Authorized Official Telephone Number: 3127368963 Field 24/33
- The 10-position telephone number of the authorized official.
- Healthcare Provider Taxonomy Code 1: 1223S0112X Field 25/33
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 1: 021.001656 Field 26/33
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 1: IL Field 27/33
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 28/33
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 261QD0000X Field 29/33
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: Y Field 30/33
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Organization Subpart: N Field 31/33
- Indicates whether the provider is a subpart of a larger organization. This is a single-character code: "Y" means the entity is an organizational subpart, while "N" means it is not. Subparts typically include hospital departments, clinics, or other distinct units that fall under a parent organization.
- Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP Field 32/33
- Specifies whether the provider is part of a single-specialty or multi-specialty business group. The possible values are: 193200000X – Multi-Specialty Group or 193400000X – Single Specialty Group. This field helps distinguish the organizational structure of a provider group.
Secondary Practice Locations 27
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
115 S Wilke Rd Ste 104
Location 1/27Arlington Heights, IL 60005-1500 · Phone (847) 253-0195
785 S Randall Rd
Location 2/27Algonquin, IL 60102-5914 · Phone (847) 854-9833
417 E Il Route 173 Unit 113
Location 3/27Antioch, IL 60002-9407 · Phone (847) 395-5550
1307 E. Rand Rd
Location 4/27Arlington Heights, IL 60004 · Phone (847) 392-4422
1401 S Arlington Heights Rd Ste 1
Location 5/27Arlington Heights, IL 60005-3700 · Phone (847) 758-0100
708 E Bethalto Dr
Location 6/27Bethalto, IL 62010-1871 · Phone (618) 377-0044
142 S Gary Ave Ste 102
Location 7/27Bloomingdale, IL 60108-2226 · Phone (630) 283-0652
183 S Bloomingdale Rd Ste 200
Location 8/27Bloomingdale, IL 60108-1400 · Phone (630) 529-2522
607 S 4th St
Location 9/27Chillicothe, IL 61523-2277 · Phone (309) 274-6237
632 S Main St
Location 10/27Creve Coeur, IL 61610-3974 · Phone (309) 698-0220
1645 S River Rd Ste 21
Location 11/27Des Plaines, IL 60018-2206 · Phone (847) 299-4811
1441 S Randall Rd Ste C
Location 12/27Geneva, IL 60134-4625 · Phone (630) 402-0359
658 Roosevelt Rd
Location 13/27Glen Ellyn, IL 60137-5819 · Phone (630) 858-0216
18340 Governors Hwy
Location 14/27Homewood, IL 60430-2910 · Phone (708) 799-0660
4113 N Johnsburg Rd
Location 15/27Johnsburg, IL 60051-6323 · Phone (815) 344-0028
1704 Patton Dr Ste 1
Location 16/27Mahomet, IL 61853-8137 · Phone (217) 586-7878
19721 Wolf Rd
Location 17/27Mokena, IL 60448-1307 · Phone (708) 479-5865
1661 Feehanville Dr Ste 420
Location 18/27Mount Prospect, IL 60056-6045 · Phone (847) 635-0117
2073 E Laraway Rd
Location 19/27New Lenox, IL 60451-9507 · Phone (815) 463-5865
7620 N University St
Location 20/27Peoria, IL 61614-1297 · Phone (309) 693-0043
1318 W Candletree Dr
Location 21/27Peoria, IL 61614-8508 · Phone (309) 692-6206
10904 N Main St
Location 22/27Richmond, IL 60071-7717 · Phone (815) 862-1112
1301 N Alpine Rd
Location 23/27Rockford, IL 61107-2262 · Phone (815) 397-4280
40W177 Campton Xing Dr Unit B
Location 24/27St Charles, IL 60175-6594 · Phone (630) 443-5000
28365 Davis Pkwy Ste 206
Location 25/27Warrenville, IL 60555-3034 · Phone (630) 836-8995
57 Danada Sq E
Location 26/27Wheaton, IL 60189-8484 · Phone (630) 528-0717
644 Sheridan Rd # 105
Location 27/27Winthrop Harbor, IL 60096-1350 · Phone (847) 872-5626
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